Next-generation RCM tools for Strategic Partners

In February, ABILITY Network acquired G4 Health Systems, Inc., the creator of a next-generation revenue cycle management (RCM) and health data analytics application. For Strategic Partners—including EMR vendors, software companies, payers and more—the G4 technology, now known as ABILITY | ACCESS RCM, provides comprehensive RCM tools. Here, Bud Meadows, Executive Vice President and Chief Revenue Officer at ABILITY; and John Carter, founder of G4 Health Systems and now Vice President of Revenue Cycle Management at ABILITY, share some details about the impacts this new technology will have for Strategic Partners.

What will ABILITY | ACCESS RCM offer to Strategic Partners?

Bud: As our Strategic Partner services have expanded over the years, we’ve grown from providing only connectivity services to adding more value-added applications that enhance the way partners can use our network. Now, we’re going even further to help our partners deliver value to their customers by providing more advanced RCM applications.

There are a couple different ways that Strategic Partners can leverage this platform. First, they can provide the platform to their customers and we can do some light integration based on their technical capabilities and availability. In the future, we plan to expose APIs within the application so our partners can integrate it at the level that makes sense for their customers and organization. Alternately, partners will have the opportunity to co-brand the application to make it complementary to their existing brand.

John: The feedback from early presentations to Strategic Partners has been very exciting. They like that we are a low impact replacement of their existing solution but with better features and functionality for their customers. As Bud mentioned, our API and our rules engine capabilities demonstrate that we’re future-ready and staying ahead of the needs of our Strategic Partners.

How does this new offering fit within the bigger picture of applications that Strategic Partners already have to choose from?

Bud: We recognize that one size does not fit all. Some people have wondered if we’ll discontinue our existing claims services, but nothing could be further from the truth. The ABILITY | ACCESS RCM platform creates a front-end claims management tool for our Strategic Partners that allows them to incorporate advanced RCM features like specific rules for individual customers. It also incorporates industry-standard edits, such as National Coverage Determination (NCD) or Local Coverage Determination (LCD), as well as looking at the Correct Coding Initiative (CCI).

Our partners have to stay competitive in the marketplace, and one of the things we’re very excited about with this platform is that we see a claims acceptance rate as high as 98%, which is one of the highest in the industry.

John: One size doesn’t fit all. ABILITY | ACCESS RCM can help Strategic Partners broaden their offerings to the marketplace with services that appeal to all types of providers, from a small ambulatory provider to a large acute care hospital. ABILITY | ACCESS RCM gives Strategic Partners options for both a consolidated and distributed approach to the RCM process.

An organization I recently spoke with wanted to know if they could up-sell portal access to an individual client provider and continue to use a traditional clearinghouse. I was pleased to say ABILITY | ACCESS RCM gives them that capability.

How is ABILITY | ACCESS RCM different from similar services?

Bud: In listening to our partners, we’ve heard that some are looking for very basic functionality. They may have already built some of the functionality that our RCM platform offers within their core application. So paying for functionality they don’t need doesn’t create value for them. To us, that partner is just as important as a partner who’s looking for a full suite of RCM applications. We truly want to listen and learn from our customers, identify how we can help, and provide the right application for their needs.

John: Exactly. Our newer platform and advanced technology isn’t crippled with all the limitations some vendors force on their customers. Some products are limited based on the number of transactions they can accept in a day; some are restricted by the kind of connectivity they offer. We give partners a great deal of flexibility with a variety of integrated transactions such as eligibility, claims, remittance and appeals as well as batch-based, API-based or blended connectivity options.

What trends on the horizon can this technology help Strategic Partners prepare for?

Bud: As we look at the transition from fee-for-service to a value-based market, we never want to lose sight of the importance of managing the revenue cycle. There is more pressure on payment amounts with reimbursements tied to quality, and the effective management of those reimbursements is critical. Timely submission of accurate claims, management of claims during the revenue cycle process, and managing ancillary processes like patient eligibility and denial management are growing in importance. Having the right tools is critical for our Strategic Partners to remain competitive in the market and stay ahead of their clients’ needs.

John: I echo Bud’s points about value-based care models. ABILITY | ACCESS RCM allows accountable care organizations to consolidate the administrative cost of billing across their institutional, professional, and laboratory providers without forcing each of those providers to be on the same medical record or patient accounting system. That’s an important component of the shared cost savings expected from the ACO model. I would also add that there continues to be a shift toward higher-deductible plans. Integrating all of the data sources necessary to accurately calculate patient responsibility at the time of service is a tough challenge. ABILITY | ACCESS RCM has laid the ground work and is positioned to grow even stronger in this area.

What else should Strategic Partners know about this new technology?

Bud: When we acquired G4, we made great efforts to assure that the company’s talent and knowledge came along. One hundred percent of G4’s staff have been retained, and we’ve created a Center of Excellence at ABILITY focused around RCM. We’ve since expanded the staff that were part of that team and have been cross-training our key departments. We’re focusing on keeping that core competency in place while scaling to support our Strategic Partners. It’s a very unique approach to acquisitions that we are proud to innovate.

John: Under the hood of ABILITY | ACCESS RCM is a coding framework that will allow us to remain agile in a dynamic industry. We’re also hosting a near fully automated clearinghouse operation with demonstrated cost of operations and performance advantages over legacy clearinghouses.

Sharing throughout the organization how to make the most of this technology is just one goal of the Center of Excellence that Bud mentioned. I’m thrilled with how everyone involved has been eager to work together, eager to learn and eager to explore ways to improve processes that help us deliver first-class results to customers both internal and external. This is an exciting time in the history of ABILITY and I couldn’t be more pleased to be a part of it.